Contrast mammography or contrast MRI, which is best for breast cancer diagnosis? Study sheds light

Austria: Contrast-enhanced MRI (CE-MRI) and contrast-enhanced mammography (CEM) showed comparable performance for identifying breast cancer, however, CE-MRI demonstrated superior sensitivity, according to a recent study in Radiology. 

In breast imaging, contrast-enhanced mammography is a more accessible alternative to contrast-enhanced MRI, but there is a lack of a summary comparison of published studies. To fill this knowledge gap, Pascal A. T. Baltzer, the Medical University of Vienna and General Hospital, Vienna, Austria, and colleagues set out to make a direct comparison of the performance of CEM and CE-MRI regarding sensitivity, specificity, and negative predictive value in detecting breast cancer.

Characteristics of studies investigating the comparative diagnostic performance of CEM and CE-MRI in detecting breast cancer were extracted by two readers. Studies published until April 2021 were eligible. Bivariate random effects models were used to calculate specificity, sensitivity, negative predictive value, and positive and negative likelihood ratios. 

A Fagan nomogram was utilized to identify the maximum pretest probability at which posttest probabilities of a negative CEM or CE-MRI examination were in line with the 2% malignancy rate benchmark for downgrading a Breast Imaging Reporting and Data System (BI-RADS) category 4 to a BI-RADS category 3 results. 

The researchers reported the following findings:

·
Seven studies investigating 1137 lesions (654 malignant, 483
benign) with an average cancer prevalence of 65.3% (range: 47.3%–82.2%) were
included. No publication bias was found (P =
.57).

·
While the positive likelihood ratio was equal at a value of 3.1
for CE-MRI and 3.6 for CEM, the negative likelihood ratio of CE-MRI (0.04) was
lower than that with CEM (0.12).

·
CE-MRI had higher sensitivity for breast cancer than CEM (97% vs
91%, respectively) but lower specificity (69% vs 74%).

·
A Fagan nomogram demonstrated that the maximum pretest probability
at which both tests could rule out breast cancer was 33% for CE-MRI and 14% for
CEM.

· Iodine concentration was positively associated with
CEM sensitivity and negatively associated with its specificity.

The authors conclude, “contrast-enhanced MRI had superior sensitivity and negative likelihood ratios with higher pretest probabilities to rule out malignancy versus contrast-enhanced mammography.”

Reference:

The study titled, “Contrast-enhanced Mammography versus Contrast-enhanced Breast MRI: A Systematic Review and Meta-Analysis,” was published in the journal Radiology. 

DOI: https://doi.org/10.1148/radiol.212530

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